Jan. 3, 2019 | View as webpage


What's in store for you as a leader in 2019? I doubt you will face the same set of challenges as 2018. Members of the EMS1 Advisory Board looked ahead to this year and the potential impacts on EMS, from climate change, to smart devices and value-based reimbursement in 2019. I also laid out the reasons I think we are on the cusp of Peak EMS – declining ambulance transports to the hospital – and that was before I learned Utah, on Dec. 31, became the first state to lower its DUI threshold to 0.05.

In this issue of the Paramedic Chief Leadership Briefing, we focus on two familiar, yet ongoing challenges for EMS leaders. I react to the recommendations and findings from the Marjory Stoneman Douglas High School Public Safety Commission, and George McNeil shares five tips for a winning EMS culture.

After reading these articles, email me with the new and familiar challenges you are anticipating in 2019, at greg.friese@ems1.com. I look forward to hearing from you.

Stay safe,

Greg Friese, MS, NRP
Editor-in-Chief, EMS1


In this issue:

By Greg Friese

The Marjory Stoneman Douglas High School Public Safety Commission issued its draft report to the Florida governor and legislature on Jan. 1, 2019. The 407-page document is a comprehensive investigation based on hundreds of interviews, hours and hours of video and audio recordings, and reports from the incident, as well as relevant pre-incident events.

On Feb. 14, 2018, a single gunman entered the school campus carrying a cased rifle. He walked into a building, uncased his semi-automatic rifle and began shooting. Fourteen students and three staff members were killed. Seventeen others were wounded.

The report begins with an incident overview and is divided into timelines, findings and recommendations by function, such as Chapter 4: School Security and Staff, Chapter 5: On Campus School Resource Officer and Chapter 7: Fire Department/EMS response. The level of detail – time stamps, locations and people – is overwhelming and I focused my reading on comprehending the overall incident timeline, and reviewing the findings and recommendations for police, fire and EMS.

It is hard to read the commission’s report or this interactive digital feature, Unprepared and Overwhelmed, from the South Florida Sun Sentinel as a paramedic and not through my lens as a parent. Twenty years after Columbine and six years after Sandy Hook, with dozens of school shootings in between, it’s remarkable how much more there is to do to prevent school shootings and minimize the loss of life should a shooter make it into the building. I doubt the commission’s findings are unique to the Broward County Sheriff’s Office, a single SRO or some of the MSD staff. It’s reasonable, to me, that we – parents, as well as responders – should expect more from public safety officials and school officials. As I reviewed the commission’s report, here are the things that stood out to me:

1. Action orientation is a critical trait of first responders and lifesavers

Many of us got into EMS, police or firefighting because of a willingness and readiness to act. If we lose our willingness to move towards risk, we either need to step away to recharge or step out of the profession. Lives depend on our courage and strength of character.

2. When you see a danger, say something and do something

You probably know the saying, “when you hear hoofbeats, expect horses, not zebras.” Several people saw the shooter on campus carrying a rifle case (see photo on page 46 of the report) and before he entered the school building. An Uber driver transported a young man with a rifle case to a high school. These hoofbeats were a 100-foot tall zebra that should have led to 911 calls, school monitors activating a code red (active shooter on campus lockdown) and the SRO rapidly moving towards the assailant.

3. Basic life safety before advanced life safety

School officials have a dizzying array of choices and solutions to prevent an active shooter and minimize the risk of injury and death. Billions are being spent on school safety improvements, but the commission report findings led to this recommendation (emphasis added) to first focus on basic life safety:

“Our schools’ greatest vulnerabilities exist because of voids in basic security policies and strategies, such as effective Code Red policies, communications/notification systems, locked doors, limited access to campuses, and designated hard corners or safe areas within student occupied spaces, that will mitigate harm. Before considering more advanced prevention-based target-hardening school safety strategies through additional funding and/or law changes, which we support, schools must ensure basic harm mitigation procedures and safeguards are in place immediately.”

As you advise school officials and teachers about active shooter response make sure these messages are prominent:

  • Lock doors
  • Move to concealment and cover
  • Notify and alert others

Review the commission’s target-hardening recommendations with the school officials in your community. Focus first on Level 1 Recommendations: policies and practices that can be implemented quickly and require little or no funding.

4. Plan and practice unified command

Fire and EMS personnel, as well as many, but not all law enforcement officers, performed as trained, admirably and heroically, to find, assess, treat and transport victims. First responders succeeded despite their commanders rather than because of their command.

The commission’s report captures the challenges of establishing a unified command, transferring command, briefing personnel arriving on the scene and acting on available information. The commission also identifies the exclusion of fire and EMS from unified command and recommends:

“Fire and EMS providers must be part of the unified command at any MCI or other significant event and fire/EMS should not have a separate command post from law enforcement.”

I suspect we can find a statement similar to this in every after-action report since Oklahoma City, Columbine, 9/11 or dozens of other events. It’s unsurprising and disappointing that command continues to be described by responders and investigators as neither unified nor inclusive.

5. Find and control bleeding

Bleeding control saves lives. All high school teachers, staff and students need to know Stop the Bleed. Every police officer needs to carry a tourniquet for self-care, buddy care or victim care. When severe bleeding is recognized and promptly treated, lives are saved.

Police officers and tactical medics identified all deceased victims and removed all of the survivors from the building within one hour of the first shots. The commission’s report describes the assessment, care and extrication of each victim from the school, including the tourniquet Detective R. Valdes applied to an injured student:

“Ashley Baez was carried out of classroom 1210 by a law enforcement officer. She was carried out of the east doors of building 12. As documented on a BSO body camera, Detective R. Valdes applied a tourniquet to her leg while they were being driven on a golf cart to the triage area. Baez was turned over to emergency medical personnel and transported to the hospital. She survived her injury.”


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In today's interconnected and complex healthcare environment, an EMS leader must understand when and how to collaborate, both within the organization and with outside partners.

This FREE white paper explores collaboration opportunities between several potential partners, and explains the process for approaching and planning out partnerships.


By George McNeil

Culture, does it mean something to your organization or is it just a soft buzzword that gets thrown around at staff meetings and in emails?

Any organization seeking change for the better should stop and examine the culture within.

Culture, good or bad, can make or break an organization. Ponder these questions as you read five tips to building a winning EMS organization culture:

  • What does culture mean to your organization?
  • What kind of culture do you have within your organization?
  • Is the culture good, bad or indifferent?

1. Don't micromanage

While this may seem like a simple concept, many leaders still don't understand that they can’t control everything. First responder services, not unlike military special operations, are highly dynamic and are made up of Type A hard-driving professionals. Micromanaging these people will almost certainly lead to conflict and have a negative impact on operational effectiveness. Conditions change rapidly, usually with a degree of unpredictability, and it is impossible for any one person to control all of the variables that feed into a situation.

TIP: Give personnel the 10,000-foot view of what needs to be accomplished, and then give them the latitude to act based on your desired outcomes. When problems arise, you can and should provide guidance, just don't take over. When you trust your people to make the right decisions, you will start to see a shift away from a bad culture to good culture.

2. Communicate your vision regularly

No matter what level of leadership you might hold, you should be communicating with your people on a regular basis. A big mistake that a lot of leaders make is they over-rely on electronic means to spread their vision.

As useful as high tech can be, remember you are leading human beings, and most human beings respond well to high touch. Get out from behind the desk and go out into the engine room or the field. Meet with people in their environment to encourage open dialogue. Good communication is a two-way street, from the top down and – just as important – from the bottom up. Use the tools at your disposal that will best support the open exchange of information.

Now there is a caveat here that I would like to highlight.

TIP: Saying too much can be just as hazardous to the culture of the organization as not saying enough. When you flood the line personnel with so much information they can’t sort through, they will lose sight of what is important and stop paying attention altogether. If what you are sharing does not have a direct impact on mission success, think hard about sharing.

3. Encourage accountability at all levels

From the senior firefighter or paramedic to the chief wearing the white shirt, one of the most important tools in your leadership toolbox is accountability. However, before people can be held accountable, they must understand the “why” behind “what” they’re being held accountable to. Every procedure, policy and guideline within the organization should have a clear statement of cause attached, and it’s your job as the leader to make sure that it’s understood.

TIP: Push your people to police themselves and hold others accountable to accomplish the overall mission of the organization. If your people don’t have a clear understanding behind certain operations, it may be time to stop, examine those operations or policies, and – if necessary – do away with them.

4. Trust your top performers

Most people who work in emergency services are highly motivated, educated individuals. On occasion, though, you will run across some that have done the bare minimum to get hired and will continue to do the bare minimum to maintain employment. These individuals will be difficult to spot sometimes because they are relatively happy in their job and won’t make waves.

TIP: The key to picking them out, is they will never do anything more than is asked of them. Don’t let this select group of individuals detract you as the leader from empowering your high-performing individuals with your trust. As the leader, you have to own everything, but you also need to give others the opportunity to shine. If you don’t, you risk losing talented and motivated people to other organizations where they can show their worth.

5. Know when to lead and when to follow

Jocko Willink and Leif Babin discussed followership in their book, “The Dichotomy of Leadership.” Just as important as stepping up to lead is knowing when to step back and let others on your team take charge and make decisions.

TIP: If you have team members who have specific knowledge or skill sets that you don’t; turn to them and use their knowledge, skills and abilities to accomplish the mission. The last thing you want to do is have the “I know it all” attitude and be left standing alone.

I hope that the tips I have presented here will help you move your organization towards one of positive culture and high performance.


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3 and out …

3. Simple reminders to avoid a PR nightmare. Start 2019 by reminding every manager, chief, firefighter, paramedic, cop and EMT of their enduring responsibility to be kind and keep the strange things that happen at work off of social media.

2. NAEMT President-Elect Matt Zavadsky talks all things EMS on the Inside EMS podcast with co-hosts Kelly Grayson and Chris Cebollero.

1. Federal government shutdown impacts public safety. Here's a breakdown of who is considered "essential" and "nonessential" during a federal government shutdown.

Share this Briefing

You are welcome to share the Paramedic Chief Leadership Briefing. Forward this email to your command staff or field personnel, print and post in the day room or training lab, or reprint in your organization or regional EMS association newsletter.

Got a leadership tip, management question, commercial use inquiry or an article idea? Send me an email at greg.friese@praetoriandigital.com.

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